title: Postdischarge outcomes in heart failure are better for teaching hospitals and weekday discharges.
abstract: BACKGROUND
  It is unclear whether teaching status or day of discharge influences outcomes after a heart failure hospitalization.
  
  
  RESULTS
  We evaluated adults discharged after a heart failure hospitalization between 1999 and 2009 in Alberta, Canada. The primary outcome was death or nonelective readmission 30 days postdischarge. Of 12 216 patients discharged from teaching hospitals and 12 157 patients from nonteaching hospitals, 20 524 (84%) discharges occurred on weekdays. Although they had greater comorbidity and used more healthcare resources before their heart failure hospitalization, patients discharged from teaching hospitals exhibited shorter lengths of stay (adjusted ratio, 0.83; 95% confidence interval [CI], 0.80-0.86) and significantly lower rates of death or readmission in the 30 days after discharge than those discharged from nonteaching hospitals (17.4% versus 22.1%; adjusted hazard ratio [aHR], 0.83; 95% CI, 0.77-0.89). Patients discharged on weekdays were older and had greater comorbidity, yet exhibited significantly lower rates of death or readmission at 30 days than those discharged on weekends (19.5% versus 21.1%; aHR, 0.87; 95% CI, 0.80-0.94). Compared with weekend discharge from a nonteaching hospital, 30-day death/readmission rates were lower for weekday discharge from a nonteaching hospital (aHR, 0.85; 95% CI, 0.77-0.94), weekend discharge from a teaching hospital (aHR, 0.80; 95% CI, 0.69-0.92), and weekday discharge from a teaching hospital (aHR, 0.71, 95% CI, 0.63-0.79).
  
  
  CONCLUSIONS
  Patients discharged from teaching hospitals or on weekdays exhibited better outcomes despite having higher risk profiles. Future studies should focus on distinguishing which discharge processes differ between teaching and nonteaching hospitals and between weekdays and weekends to define those that optimize patient outcomes.
authors.affiliation: Division of General Internal Medicine, and Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Canada.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Anita G
authors.initials: AG
authors.lastname: Au
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Erik
authors.initials: E
authors.lastname: Youngson
authors.forename: Raj S
authors.initials: RS
authors.lastname: Padwal
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: heart failure; internal medicine; mortality rate; patient readmission